Reproductive performance and three-dimension-ultrasound volume determination of polycystic ovaries after laparoscopic ovarian drilling

Abstract

Laparoscopic treatment of polycystic ovaries is a less invasive technique than ovarian wedge resection by laparotomy and is associated with less adhesion formation. Furthermore, the results appear to be superior. The purpose of the current study was to determine the changes in the ovarian volume and the reproductive outcome after laparoscopic treatment of polycystic ovaries. We studied 34 women with polycystic ovary syndrome (PCOS) who failed to ovulate with clomiphene and who subsequently underwent laparoscopic ovarian drilling. A standard procedure was done by a single surgeon using an insulated needle electrode. In six patients, ultrasound examination was performed to determine three-dimensional volume before surgery, and 1 week and 3 weeks postoperatively. Preoperative volume was 12.2 &plusmn; 1.8 cm3 and 1 week after surgery it was 13.6 &plusmn; 1.5 cm3. The ovarian volume 3 weeks after surgery (6.9 &plusmn; 1.3 cm3) was significantly smaller than that before surgery (p <0.05). Ovulation after the procedure occurred in 30 women (88.2%). Using life table analysis, the cumulative probability of conception at 12-month follow-up was 70% (median 8.1 mo). Two patients (6%) who did not ovulate with gonadotropin previously refused further expectant treatment after surgery and conceived in the first cycle of gonadotropin treatment. Aside from these women, the majority of pregnancies (76%) occurred spontaneously, and 18% conceived with clomiphene. We observed for the first time that there is a temporary swelling of the ovary after laparoscopic ovarian drilling. Subsequently, the volume decreases to the size smaller than the preoperative volume. Laparoscopic treatment of polycystic ovaries in women with PCOS who fail clomiphene therapy is associated with an ovulation rate of 88.2% and a pregnancy rate of 70% at 12-month follow-up.